Assessment of the Contribution of the Work Relative Value Unit Scale to Differences in Physician Compensation Across Medical and Surgical Specialties

Abstract

IMPORTANCEThe work relative value units (wRVUs) for a physician service can be conceptualized as the amount of time spent by the physician multiplied by a compensation rate (wRVUs/min). Disproportionately high compensation rates assigned to procedures have been blamed for pay differences across specialties, but to our knowledge, a comprehensive assessment is lacking.OBJECTIVE To assess how compensation rates built into work RVUs contribute to differences in physician compensation across specialties.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis examined 2017 Part B fee-for-service Medicare data. The data were analyzed from May 1 to May 30, 2019. MAIN OUTCOMES AND MEASURESA specialty-wide compensation rate (wRVUs/min) was generated for 42 medical and surgical specialties defined as the sum of wRVUs for all billed current procedural terminology codes divided by the presumed time to perform those services. This measure accounted for the volume and diversity of services each specialty provides. Sensitivity analyses were performed to assess the association of errors in wRVU time estimates with average compensation rates. RESULTSThe final sample included 42 specialties and 6587 distinct Current Procedual Terminology (CPT) codes. The number of CPT codes attributed to a specialty ranged from 575 (medical oncology) to 4346 (general surgery). Compensation rates ranged from 0.029 wRVUs/min (pathology) to 0.057 wRVUs/min (emergency medicine). Most specialties (34/42 [81.0%]) had compensation rates between 0.035 and 0.045 wRVUs/min. The mean compensation rate for surgical specialties was 7.2% higher than for medical specialties, a difference that was not statistically significant. This narrow range reflects the fact that most specialties had more than 60% of time allocated to activities outside the intraservice period. Assuming that time values for surgical procedures are significantly overestimated increased the difference in average compensation between surgical and medical specialties to 23.4%.CONCLUSIONS AND RELEVANCE Compensation rates assumed in wRVU valuations are small contributors to differences in physician compensation. Factors outside of the wRVU system, such as payer mix and work hours, could be targeted if narrowing the difference in compensation across specialties is desired.

Does the reform of public hospitals' payment system increase the pay of medical personnel? A nationwide cross-sectional study

“…The findings also align with UK research that found that a proposed new contract payment structure could lead to the pay rise for junior doctors with the most onerous shifts but did not provide much financial compensation for junior doctors who work every other weekend [25]. Third, the pay of medical personnel was strongly associated with the average salary of an urban worker and the hospital type, and the worker's gender, age, education status, work characteristics, position, professional titles, seniority and departments, which is consistent with previous studies [26].…”

Procedural and geographic variation in price markup of common rhinology procedures by otolaryngologists in the United States

“…The American Medical Association's RUC meets three times per year to review survey results from physicians to determine the RVUs for each CPT code that physicians bill for. This, in turn, determines the amount a provider will be reimbursed based on the anticipated time, risk, mental and physical effort required for care 4,5 . Secondary to the subjective nature of quantifying these categories, this is subject to inherent variability, particularly when members of the RUC disproportionately belong to procedure‐based specialties 4–6 .…”

“…This, in turn, determines the amount a provider will be reimbursed based on the anticipated time, risk, mental and physical effort required for care. 4,5 Secondary to the subjective nature of quantifying these categories, this is subject to inherent variability, particularly when members of the RUC disproportionately belong to procedure-based specialties. [4][5][6] The RVU system is prone to implicit bias and may force facilities to use the chargemaster prices to correct for this, potentially leading to significant variability in the MUR of certain procedures.…”

“…4,5 Secondary to the subjective nature of quantifying these categories, this is subject to inherent variability, particularly when members of the RUC disproportionately belong to procedure-based specialties. [4][5][6] The RVU system is prone to implicit bias and may force facilities to use the chargemaster prices to correct for this, potentially leading to significant variability in the MUR of certain procedures. When paralleled to two previous studies that performed similar MUR analysis among eight commonly-performed major surgical procedures among all specialties 7 and seven common otologic procedures, 8 our results suggest that the median MUR among commonly-performed rhinology procedures (2.47 [IQR]: 1.85-3.69) is lower than that of commonly-performed surgical procedures and comparable to that of commonly-performed otology procedures (median MUR of 3.5 [IQR: 3.1-4.0] and 2.42 [IQR:1.93-3.09], respectively).…”

Compensation Rates for Otolaryngologic Procedures Under the Medicare Physician Fee Schedule in 2018

“…We calculated these rates using the building block method (Supporting Figure). 3,7,10 This previously established method divides physician work into four non-overlapping blocks: 1) pre-service work, including pre-operative evaluation, dressing/scrubbing/ waiting, and patient positioning; 2) intraservice work from incision to closure (i.e., "skin-to-skin" time); 3) immediate post-service work (e.g., patient care in the post-operative recovery room); and 4) global period work (as applicable), such as inpatient rounding and outpatient clinic visits following surgery (Fig. 1).…”